Family planning and adolescent pregnancy

Characterizing Family Planning Utilization in Adult Women and Adolescents in Pohnpei, Federerated States of Micronesia

INTRODUCTION

Increasing family planning xutilization in low-income countries to improve health outcomes of women and children is a global priority. The Federated States of Micronesia (FSM) has poor maternal child health outcomes; therefore, this study aimed to examine family planning utilization in Pohnpei State, FSM.

METHODS

This cross-sectional study sought to characterize family planning utilization in adult women of reproductive age and high school age adolescents in Pohnpei using representative survey data collected in 2019 (N = 570 and N = 1726, respectively). Chi-square tests were used to determine significant factors associated with family planning utilization.

RESULTS

Among adult women of reproductive age (18-49 years old) not trying to get pregnant, 31.6% reported using contraception during last intercourse. Contraceptive use was significantly lower among younger women (18-24 years old) (21.7%, p = 0.021), unmarried women (18.6%, p < 0.001), those without health insurance (28.7%, p = 0.030), those who have never had a pap smear (20.5%, p < 0.001), and those who have never been pregnant (14.5%, p < 0.002). Among adolescents who reported being sexually active, 28.5% reported using any contraception at last intercourse and 22.6% reported using a condom at last intercourse. Condom use among sexually active adolescents was lowest among 12th graders (13.5%, p < 0.001) and girls (16.8%, p = 0.004).

CONCLUSIONS

Our findings suggest that young, unmarried, never pregnant women face an unmet need for family planning. Additionally, women with lower access to and use of healthcare services have lower use of family planning.

Cost analysis for deliveries according to maternal age classes for moving to a personalized approach in the health care

Objective: In the last decades, childbearing has moved to higher ages, displaying adverse outcomes related to advanced maternal age at birth. Accordingly, the aim was to perform a cost analysis in women admitted for birth assistance and segregated by age classes (<20, 20-24, 25-29, 30-34, 35-39, 40-45, and ≥45 years).Methods: A total of 18,093 admitted for assistance at delivery in a 5-year period (2012-2016) were included in the analysis. Costs for obstetric complications in vaginal delivery (VD) and cesarean section (CS), based on hospital discharge report from the local health care system, were calculated by using the "diagnosis-related group" (DRG) approach.Results: An overall economic cost due to clinical assistance at delivery of €42.663.481 was computed. A global rate of 59.6% of vaginal deliveries (VD) and 40.4% of cesarean section (CS) was assessed. Among of all maternal age classes, women attributable to classes 30-34 and 35-39 years reached a rate of 62.8%, while values of 24.2 and 13% were observed for those under 30 and over 40 years of age, respectively. A significant increasing trend in terms of maternal stay duration was found across all age groups (from 4.7 to 5.4 days, p < .05), as well as nonspecific delivery costs (from €2.222.49 to €2.401.29, p < .05). Uncomplicated VD decreased across the groups, until to halve between two extreme maternal age groups (38.8 versus 18.6%, p < .05), while a three-fold risk of CS complications was calculated in women over 45 years-old in comparison with those under 20 years of age (4.2 versus 13.9, p < .05), although not significantly different in the cost analysis between two extreme age groups.Conclusions: Increases in maternal age at delivery are associated with higher healthcare costs, driven largely by additional complication rates, irrespective of the delivery mode.

Differences in abortion attitudes by policy context and between men and women in the World Values Survey

We explored whether abortion attitudes differed by respondents' sex and country-level abortion policy context. Data were collected between 2010 and 2014 from 69,901 respondents from 51 countries. Abortion attitudes were scored on a ten-point Likert scale (1 = "never justifiable"; 10 = "always justifiable"). Country-level abortion policy context was dichotomized as "less restrictive" or "more restrictive." We conducted linear regression modeling with cluster effects by country to assess whether respondents' sex and abortion policy context were associated with abortion attitudes, controlling for sociodemographic characteristics. On average, women had more supportive abortion attitude scores than men (Mean = 3.38 SD = 2.76 vs. Mean = 3.24 SD = 2.82, p < .001). Respondents in countries with more restrictive policy contexts had less supportive attitudes than those in less restrictive contexts (Mean = 2.55 SD = 2.39 vs. Mean = 4.09 SD = 2.96, p < .001). In regression models, abortion attitudes were more supportive among women than men (b = 0.276, p < .001) and in less restrictive versus more restrictive countries (b = 0.611, p < .001). Younger, educated, divorced, non-religious, and employed respondents had more supportive scores (all p < .05). Systematic differences were observed in abortion attitudes by respondents' sex and policy context, which have potential implications for women's autonomy and abortion access, which should be explored in future research.

Factors influencing repeated teenage pregnancy: a review and meta-analysis

OBJECTIVE

Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus.

DATA SOURCES

We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997-2015 and the reference list of other relevant research papers and related reviews.

STUDY ELIGIBILITY CRITERIA

Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention.

STUDY APPRAISAL AND SYNTHESIS METHODS

We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity.

RESULTS

Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35-1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08-0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60-0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33-0.84), were found to be protective. Conversely, depression (pooled odds ratio, 1.46; 95% confidence interval, 1.14-1.87), history of abortion (pooled odds ratio, 1.66; 95% confidence interval, 1.08-2.54), and relationship factors, such as partner support, increased the repeated teenage pregnancy risk.

CONCLUSION

Contraceptive use, educational factors, depression, and a history of abortion are the highly influential predictors of repeated teenage pregnancy. However, there is a lack of epidemiologic studies in low- and middle-income countries to measure the extent and characteristics of repeated teenage pregnancy across more varied settings.

Measuring the distribution of adolescent births among 15-19-year-olds in Chile: an ecological study

BACKGROUND

Although within Latin America Chile has one of the lowest birth rates among adolescents, it has a high rate in comparison to other developed nations.

AIM

To explore trends in birth rates among adolescents by selected demographics in Chile.

METHODS

The national trend in birth rates was examined for women aged 15-19 years between 1992 and 2012. The birth rates for regions and communes were calculated using birth and census data and were analysed to determine its relationship to the regional or communal poverty rate, which were obtained from the Casen Survey. Differences in educational attainment were explored among adolescents with first-order and second-order or higher births using the Chi-square test.

RESULTS

The birth rate among adolescents has experienced a 25% decline in the past 20 years. Cross-regional variance in birth rates could not be explained by poverty rates. Within the Metropolitan Region, there is a positive correlation between poverty and adolescent birth rates. Among adolescents giving birth, 67% had completed 10-12 years of school at birth, but there is a significant difference in educational attainment between girls with a first-order and those with a higher-order birth.

CONCLUSIONS

In Chile, the adolescent birth rate varies greatly among regions and communes. This study found that urban and wealthy areas had lower birth rates than poor and rural ones, and that girls with a first-order birth had completed more years of school than girls with higher-order births.

Antenatal Education on Pregnant Adolescents in Turkey: Prenatal Adaptation, Postpartum Adaptation, and Newborn Perceptions

PURPOSE

This clinical trial study was planned in order to evaluate the effect of antenatal education on antenatal and postpartum adaptation and newborn perceptions among adolescent pregnant women.

METHODS

A research assistant met with pregnant adolesencents in a Family Health Center and at the participants' homes. The sample included 70 pregnant adolescents (35 in experimental group, 35 in control group) chosen through simple random sampling. The experimental group received antenatal eduation, whereas the control group merely had routine surveillance. As for data collection tools, the Prenatal Self Evaluation Questionnaire (PSEQ), the Postpartum Self Evaluation Questionnaire (PPSEQ) and the Newborn Perception Scale (NPI) was used.

RESULTS

It was found that the experiment group who received antenatal education had a lower mean total PSEQ score (133.94 ± 15.62) compared to the control group (159.86 ± 17.83). In the comparison of two groups, it was determined that the experiment group had lower mean total PPSEQ scores on the 1st day, 1st week and 2nd week compared to the control group, indicating higher levels of postpartum adaptation (p = .017, p = .009, p = .029).

CONCLUSION

It was determined that the level of prenatal adaptation was higher in the experiment group, which received antenatal education, than in the control group and that levels of postpartum adaptation was significantly higher in the experiment group on the 1st postpartum day and the 1st and 2nd postpartum weeks but not on the 4th postpartum week. There were no significant differences between the experiment and control groups in terms of NPI results.

Maternal adjustment and maternal attitudes in adolescent and adult pregnant women

STUDY OBJECTIVE

This study analyzes differences between adolescent and adult pregnant women and the contribution of maternal age to maternal adjustment and maternal attitudes during pregnancy.

DESIGN, SETTING, AND PARTICIPANTS

A sample of 398 Portuguese pregnant women (111 younger than 19 years) was recruited in a Portuguese Maternity Hospital and completed the Maternal Adjustment and Maternal Attitudes Questionnaire between the 24(th) and 36(th) weeks of gestation.

MAIN OUTCOME MEASURES

Maternal Adjustment and Maternal Attitudes Questionnaire(1) RESULTS: Adolescent pregnant women show lower maternal adjustment (poorer body image and worse marital relationship) and poorer maternal attitudes (more negative attitudes to sex) than adult pregnant women. When controlling for socio-demographics, age at pregnancy predicts poorer body image and more negative attitudes to sex, but not a worse marital relationship, more somatic symptoms or negative attitudes to pregnancy and the baby. A worse marital relationship was better predicted by living without the partner, and more somatic symptoms and negative attitudes to pregnancy and the baby was predicted by higher education.

CONCLUSION

Adolescent pregnant women show lower maternal adjustment and poorer maternal attitudes than adult pregnant women according to socio-demographics and unfavorable developmental circumstances.

Planejamento familiar: uso dos serviços de saúde por jovens com experiência de gravidez

Objetivou-se analisar o uso de serviços de planejamento familiar por jovens com experiência de gravidez. Trata-se de estudo transversal realizado com 464 jovens que finalizaram uma gravidez no primeiro quadrimestre de 2006, quando tinham entre 15 e 19 anos, em seis maternidades de Teresina. Os dados foram coletados em 2008, por meio de formulário pré-codificado e pré-testado. A análise multivariada apontou que jovens de menor renda, maior número de gestações, que têm como fonte de informação profissionais de saúde, família e parceiro, e que usaram método contraceptivo nas últimas relações sexuais eram mais propensas a serem usuárias dos serviços de planejamento familiar. Aproximadamente 55,0% das jovens afirmaram que buscariam um serviço especializado para sua faixa etária, ainda que distante de sua residência. Constatou-se a necessidade de investimentos em serviço especializado para jovens, com características próprias que facilitam o acesso precoce, bem como atendam aos anseios das jovens que mesmo tendo vivenciado uma gravidez na adolescência, não utilizam os serviços de planejamento familiar disponíveis.

Unplanned pregnancy in adolescents: association with family structure, employed mother, and female friends with health-risk habits and behaviors

Previous publications have suggested that living in a nonintact family household and socializing with girlfriends who smoke or who consume alcoholic beverages favor the development of health-risk habits and customs in adolescents. However, their relationship with unplanned pregnancy in adolescents has not been determined. We investigated the association between family structure, employed mother, and female friends with health-risk habits and behaviors with unplanned pregnancy in adolescents (n = 3,130). After adjusting for low maternal educational level and low family income, logistic regression analyses showed that having an employed mother and socializing with girlfriends who have health-risk habits or behaviors, rather than living in a nonintact family household, appear to be the most important health-risk factors for unplanned pregnancy in adolescents. It is important for health-care programs for adolescents to be revised and for their strategies be strengthened in order to reach the objectives for which they were created.

Association between child marriage and reproductive health outcomes and service utilization: a multi-country study from South Asia

PURPOSE

Despite the pervasiveness of child marriage and its potentially adverse consequences on reproductive health outcomes, there is relatively little empirical evidence available on this issue, which has hindered efforts to improve the targeting of adolescent health programs. The purpose of this study was to assess the association of child marriage with fertility, fertility control, and maternal health care use outcomes in four South Asian countries: India, Bangladesh, Nepal, and Pakistan.

METHODS

Data for the study come from the most recent Demographic and Health Surveys conducted in the study countries; we used a subsample of women aged 20-24 years. Child marriage, defined as first marriage before 18 years of age, is categorized into two groups: first married at ages 15-17 years and first married at age ≤14 years. We used multivariate logistic regression models.

RESULTS

The results of the study suggest that child marriage is significantly associated with a history of rapid repeat childbirth, current modern contraceptive use, female sterilization, not using contraception before first childbirth, pregnancy termination, unintended pregnancy, and inadequate use of maternal health services, although the associations are not always consistent across countries. Furthermore, women who married in early adolescence or childhood show a higher propensity toward most of the negative outcomes, compared with women who married in middle adolescence.

CONCLUSIONS

Child marriage adds a layer of vulnerability to women that leads to poor fertility control and fertility-related outcomes, and low maternal health care use.

Análise comparativa das gestações e da frequência de prematuridade e baixo peso ao nascer entre filhos de mães adolescentes e adultas

OBJETIVO: Realizar uma análise comparativa entre frequência de prematuridade e baixo peso ao nascer entre recém-nascidos de mães adolescentes e adultas, e avaliar dados maternos selecionados. MÉTODOS: Estudo de coorte comparativo, envolvendo 703 gestantes internadas em hospital público da cidade de São Paulo e seus recém-nascidos (270 mães entre 10 e 19 anos e 433 entre 20 e 35 anos), no período de março a agosto de 2003. RESULTADOS: O nascimento de crianças prematuras ou com baixo peso não foi predominante em nenhuma das faixas etárias; pequenas diferenças encontradas não foram estatisticamente significativas. No entanto, foram encontradas diferenças significativas entre os dois grupos etários nos quesitos: número de gestações, predominando maior número de primeiras gestações entre as adolescentes (70,3%) e maior número de segundas ou terceiras entre as adultas (26,9 e 53,3%, respectivamente) e, no pré-natal, predominando menor número de consultas entre as adolescentes e maior entre as adultas (45,1% e 63,3%, respectivamente). CONCLUSÃO: O grupo de gestantes adolescentes, na população estudada, não diferiu do grupo de adultas, quanto à frequência de prematuridade e ao baixo peso ao nascer. Entre as adolescentes, houve significativamente maior número de primíparas, em relação às adultas, e menor número de consultas pré-natais.